HomeMy WebLinkAbout1136 Declaration ot Dorr~iCile and Citisenship
TO TNE STATE AND COUNTY TAX ASSESSOR, • ~
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Sl. IUCIE COUNTY, FLORIDA: ~
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This is my declaration of Domiciie and Citizenship in the State of Flo~ida that 1 am filing this day in actordance and ~
~n conformity w+th Chapter 222, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident o~~21 _ _ _ _ - - _ - - i
• C;ty~ (State) :
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and I resided at~ `='-`'~Lf~(/~
~~G - - - However 1 have changed my domitule ~
(Street and Number) ~
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ro and am and have been a bona fide resident of the State of Florida since day of ~
> y~L -
_ 19~v~i, and I reside at `SJ ~
~.~r c~,.~l/`=~ L=-i'`t-.- J;
L L/, ~Gtc-<-'
(Street and Number) 33 ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State nf Florida.
(tnsert here any pertinent tacts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.) 's
~ ~-L-~-n-~ 223251
FIlEO 1tNfl aECORDEO
ST.lUC1E COUNTY F~A.
ROC,:' FOITR~S
Cl~RK C'=:C~J!T CO~RT
RE~Or~ ~EGt:;rp~~.~.~
FEe 3 ! s2 PH '11 ;
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~ 1 FURTHER CfRTIFY that I will comply with all other requirements of a legal resident of this State. i
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~ ~ FURTHER CERTIFY that I have no intention to return to my former domiule, and 1 intend to remain in FORT ;
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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(Name)
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Sworn to and subscribed before me this day of , 19L~"Z
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ROGER POITRAS - ~
- K CIRCUIT URT Notary Public ~
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By D.C. My Commission expires
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(To be executed in duplicat~ and original filed witb Cl~rk Grcuit Cour~, and duplicaN with Tax Ass~ssor.) ~
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V~: BooK 1~ PACf
1135 `
No 13 A
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